The Best of Us

by Joyce Maynard

  I pictured how it would be later, sometime between now and dawn, when the animals in the canyon discovered what was there—the feast attended by raccoons, deer, and who knew what else—maybe mountain lions and foxes. We might hear the coyote howling on the hill that night. But no rock and roll.

  47.

  Almost ten months before this—before cancer, and bilirubin counts, and endoscopies, and Avastin, and 5-FU, and neuropathy—we had made the plan to gather as many of our children as we could at my house on Lake Atitlan for a big family holiday together, our first with the children. All three of my kids—Audrey, Charlie, and Willy—were up for the trip, along with two of their partners. Those plane tickets had not come cheap, but never mind. It was a dream for us, to be together with at least some of the children this way.

  After Jim was diagnosed, when the kids asked if we were planning to cancel Christmas, we told them no way. We’d be there. But as the month wore on, and the chemo began taking effect—Jim’s beautiful hair gone, along with so much else—we realized it would be impossible for us to make that trip.

  My younger son and daughter and their partners still flew to Guatemala. Jim and I spent a quiet Christmas alone, though on New Year’s Eve, we dressed up and headed across the bridge to a party. Jim was as handsome bald as he had been with hair, though in other ways his face had changed dramatically. Not just because it was thinner, and more lined; even when he smiled for the camera, there was a look in his eyes that didn’t used to be there. Studying pictures now, I realize there was a look in mine too.

  48.

  In January we began to question the wisdom of continuing to make our trips to Dr. Miracle. Partly this had to do with discussions Jim had with members of the breakfast group, a couple of whom had consulted the miracle doctor themselves at various points along the way in their treatment. We’d been reading about Avastin, and it was hard to know what to make of these articles, but as much as we wanted to believe that this doctor had hit on a way to attack adenocarcinoma of the pancreas as no others had, I could find no evidence in the medical literature that those $6,000-a-week infusions made any difference in the outcome of the disease. In my telephone conversations with pancreatic cancer treatment facilities around the country, when I mentioned who was treating Jim and recited his treatment protocol, I would register a slow intake of breath on the other end of the line, the measured words that almost invariably followed.

  But for us the deciding factor in our decision to discontinue the Avastin had been something else. Early on, when Jim had first gone to Dr. Miracle, I had asked his chief medical assistant if she could provide me with the names of patients he’d treated who’d survived for over five years, post-Whipple, other than the one I’d heard about from my agent, Judi. Recognizing that she would not be in a position to give out their phone numbers, I asked if she’d let these patients know how much I wanted to speak with these long-term survivors and give them my phone number.

  One called. One only.

  I asked again. Still waited.

  Then I asked to read any papers Dr. Miracle might have published on his treatment protocol. He showed me a draft of one, unpublished.

  After that first visit when we’d signed on for treatment, Dr. Miracle never had time to address my questions about Jim’s treatment. Whereas on that first day in his office, he had spent over ninety minutes with us discussing his approach to treatment and the reasons why every other oncologist in the field was doing everything wrong, now he ignored my messages. Once I rode all the way to L.A. with Jim in the hopes that I’d have more luck getting Dr. Miracle’s ear if I showed up in person rather than calling, but that time, when I’d asked if I could have a few minutes to speak with him before my husband’s infusion, the assistant had come back to report that it was an unusually busy day. A conversation of even the shortest duration would not be possible.

  One of the people with whom I discussed the choice to leave Dr. Miracle—though we never met—was Liza, another wife of a man with pancreatic cancer, who was also making the weekly trip to L.A. from the Bay Area and shelling out the three-times-a-month Avastin check. Liza agreed with me: Dr. Miracle could be maddening, but she and her husband, Art, had made the decision—equally agonizing—to stick with his treatment regimen.

  “How are any of us supposed to know what’s the right thing here?” she said to me, over the phone. “We aren’t doctors. And even the doctors don’t really know. You can drive yourself crazy, thinking about all the things you might be doing, or the things you’re doing that might be dead wrong.” Dead wrong. There was a phrase for you.

  After much debate, Jim and I concluded together that his odds were better in one of the more mainstream pancreatic cancer programs—so long as it was the very best. We canceled the next trip we’d had planned for L.A., with the resolve that we would go anywhere, spend whatever it took getting there. We just needed a doctor—a team, actually, not a lone cowboy—whom we trusted.

  What to do, what to do? I could talk on the phone all day with people at pancreatic cancer programs around the country, read papers, haunt the PanCan website, call up pancreatic cancer survivors—or the widows of those who had not survived—hearing about where they went, what drugs they were given, which surgeon performed their Whipple. But in the end, all we could do was trust our instincts.

  “Boatmen on the River Styx,” Jim called the surgeons and oncologists—these gods you sought out, in search of the elusive cure. Not even the cure, really—just the chance of getting a green light for the Whipple procedure. I did not ask myself this other question: Suppose it didn’t even matter where you went, or what drugs they treated you with, or what berries you ate or did not eat, or whether you got CyberKnife radiation or immunotherapy—whether the surgeon had gone to Harvard or Stanford or Penn? What if this cancer were simply so deadly that the person you loved was going to die anyway?

  We were in the world’s most high-stakes gambling event, where you got one card to play—one shot—and if you chose wrong, you died. You might die anyway, but that was another story. We weren’t going there.

  49.

  I heard about another possible miracle worker. His name was Dr. Ronald Weiss, and he practiced medicine in New Jersey. Though he had received conventional training in Western medicine, and for years had worked with patients in a hospital setting, Ron Weiss had gradually shifted his focus—a little at first, then more and more, and now totally—to the philosophy that no better form of treatment existed than eating the right foods and eliminating everything else but those foods from one’s diet.

  Unlike most physicians who tended to put so little emphasis on nutrition and diet, Ron Weiss had long been a believer in healthy vegetarian eating. But for him the turning point had come many years earlier when, just as he was completing his own medical training, his father had been diagnosed with Stage 4 pancreatic cancer and given months to live.

  Though at the time Ron Weiss was very young—just starting out in his practice of medicine—he resolved to seek out a way of helping his father that went beyond what the doctors had offered.

  With nothing to lose, he put his father on a strict macrobiotic diet, eliminating all animal proteins. He augmented this diet with a number of foods and spices he believed to possess specific cancer-fighting properties. (Now, he said, he knew about far more of these foods, but even then he was aware of a few. Turmeric. Berries with high antioxidant content.) In addition to animal proteins, he eliminated all sugar from his father’s diet—also oils, salt, and virtually anything that might have enhanced flavor.

  “Pleasure is a trap,” he said. “Pleasure leads to consumption of unhealthy foods.”

  Ron Weiss’s father was in his seventies by this point, and never one to abstain from meat or salt or sugar. But he had gone along with his son’s experiment. And when he did an amazing thing had happened. His health began to improve.

  Twelve months after the diagnosis of pancreatic cancer—his weight stabilized, his energy restored�
��Ron Weiss’s father returned to the office of the doctor who’d given him the death sentence. When the doctor saw him, he reacted as if he’d seen a ghost.

  Ron told us his father had lived another year after that, subsisting on an adapted form of the macrobiotic diet. Eventually the cancer returned, and when it did it had killed him swiftly. Still, Dr. Weiss believed that healthy eating had given his father an extra two years of good quality life. (Not exciting dining experiences, but never mind. As much as I loved food, and loved cooking, I would have agreed to subsist forever on kale and pomegranates if it would have kept Jim alive.)

  This experience had formed the beginning of the practice Dr. Weiss had built, focused entirely on food as medicine. Eventually, he’d left his mainstream medical practice, bought a farm in northern New Jersey where he oversaw the cultivation of organic crops, assisted by a full-time organic farm manager and a dietician named Asha who shared his passionate commitment to curing illness through diet. They had recently opened their doors to a range of patients suffering a variety of medical issues from obesity to heart disease to cancer.

  I had read this much in an article online. That was enough to convince me that Jim and I needed to speak with this man.

  It was seven P.M. on a Saturday night the first time I called Ron Weiss to ask if he could help. This would have been ten P.M. Eastern time. But sixty seconds after I left my message he called me back.

  We talked for over an hour. By the time we rang off it was decided: Jim and I would fly to New York City that coming weekend, borrow my friend David’s car, and drive to northern New Jersey to stay at Ron Weiss’s farm, Ethos. We’d spend a week there, learning how to prepare foods that could help Jim, and receiving an education in Ron Weiss’s brand of medicine.

  Dr. Weiss wasn’t a salesman, but he told us he would make it his mission to lower Jim’s CA19-9 count sufficiently over the course of those few weeks that Jim might open his mind to a natural approach to the treatment of his cancer. No doubt the prospect of getting a chance to cure, in Jim, the very cancer that had killed his father, contributed to Ron’s passion for helping Jim.

  “I’m not going to promise you anything,” he told us on the phone that first night. “All I can tell you is that I’ll give you everything I’ve got. I’ve waited twenty-two years for the chance to apply what I’ve learned since my father’s death to another pancreatic cancer patient’s situation. I believe I can help you.”

  We booked our tickets to fly east. By the time we arrived at Ethos Farm, Ron had devoted days to reading up on the chemistry of pancreatic cancer cells and foods that might be best equipped to combat it. He had put together a long list of herbs Jim was to consume in massive quantities, three times a day, along with the more standard macrobiotic fare. Some of these foods took so long to prepare—and so long to eat, because of the quantities Jim was required to consume—that it seemed as if our entire day was spent chopping, preparing all those bitter herbs and organic vegetables and then chewing the giant pleasure-free salads we prepared in bowls as big as troughs—only to resume preparation for the next meal almost as soon as that one was finished.

  We were the only patients at the Ethos Health Center that week, and among the first patients there ever, which meant that we received the virtually undivided attention of Ron and Asha. From early morning to the end of every day, we worked with those two—me, alongside Jim, living on the same diet. Sometimes we’d listen to a lecture on some aspect of the diet, or on the importance of meditation. Other times we’d participate in a cooking lesson. There was no salt in anything we ate. No oil. No wine to accompany our meals. No coffee.

  For our part, we were not going to abandon chemotherapy. But Ron asked us to give his diet one month. “Let’s measure your blood levels and tumor markers before we begin treatment, and again four weeks later,” he said. “I believe we will see significant improvement.”

  Once again, committing to one course of treatment over another felt like a huge gamble. We could not afford to lose valuable time treating the cancer. But after long conversations with Dr. Weiss, Jim and I decided to see what might be possible if Jim gave himself an extra week off of chemotherapy while adhering to the diet. This would place him two weeks beyond the normal interval between most chemotherapy infusions, which felt like an acceptable space of time to give the alternative treatment a try. Not a lot of time to witness improvement, but Dr. Weiss believed that even in such a short time, Jim might begin to feel better.

  Looking back on our decision now to interrupt chemotherapy for those two weeks, I ask myself if this might have been a moment—or one of them—when we made a fatal call. What might it have meant to Jim’s prognosis that we stepped away from the chemotherapy as we did? Much as the Norway rat outside our bedroom, whose footsteps we still heard in the night, had wised up to the workings of every trap we’d laid out, I could see the cancer cells mutating new ways to render themselves invulnerable to every form of chemotherapy drug we threw at them. Was that December the month some rogue cell made its way into Jim’s liver?

  Still, it felt good to be putting something healthy into Jim’s body instead of filling him with poison. Knowing, too, how little in the way of hope the world of mainstream medicine was offering us, it was impossible not to feel drawn to exploring a different route from those already proven to offer only the barest possibility of success.

  I liked Asha and Dr. Weiss. His belief in the form of treatment he practiced was passionate and informed by a great deal of research, though research outside the mainstream. All that week we spent in New Jersey I carried around the book he recommended to me—The China Study—reading passages out loud to Jim when something struck me as particularly important and persuasive. “Listen to this,” I’d say, and reel off another amazing fact about the curative properties of a particular herb, and the cancer-promoting properties of sugar, or—conversely—the machinations of the drug industry.

  In all our many consultations with Dr. Weiss that week, he did not weigh in on the advisability of undergoing the Whipple procedure. But one conversation we had stands out for me. It happened near the end of our time together.

  “Perhaps, if you feel good about the results you get by living on this diet, you may opt not to have the Whipple procedure after all,” he told us. “Even if it becomes an option, as it well may.”

  At the time, I supposed that Dr. Weiss was suggesting his diet might actually cure Jim’s cancer on its own, without benefit of surgery—and this sounded unrealistic and rash. As much credence as I might give to the benefits of turmeric and blueberries and all the rest of the foods Ron and Asha had offered up to us, it seemed impossible to suppose that a food—any food—could eradicate a form of cancer as deadly as this one.

  Much later, I thought back on what Dr. Weiss was saying to us that day. This time it struck me differently. I think he might have been trying to convey something else to Jim and me, besides our need to believe that this diet of his might cure pancreatic cancer. Very gently—because it would have been hard if not impossible to deliver this assessment in plain, hard language to the people we were then, who were still so desperately attached to the dream of a cure—I think he may have been suggesting that we might actually do better bypassing Whipple surgery and adhering to his diet not as a way of permanently eradicating the cancer, but as an alternative to a brutal procedure whose odds for saving Jim’s life struck him as impossibly low.

  Perhaps he was quietly suggesting that it might be wiser to get a good year or two in, without surgery—as his father had, eating in a manner that could slow down the growth of cancer for as long as possible, with the hope that Jim might actually manage to feel good for a significant portion of that time.

  If he had said this to us at the time, I could not have accepted his words. In our innocence and desperation, we had chosen to view “getting the Whipple” as akin to reaching the promised land. Ron Weiss, who had no doubt seen plenty of patients in the aftermath of that eviscerating procedure, kn
ew better—as we would too, one day.

  When the week in New Jersey was over, we flew home, but for some time we kept to the diet Ron and Asha had given us. Because pomegranates were a crucial part of the program they’d designed for Jim—and pomegranate season was ending—we made a trip to the Berkeley Bowl and bought up every single pomegranate they had in the store—over a hundred of them—that we stored in the backup refrigerator we had, whose function we had initially envisioned as keeping beer cold for parties.

  Now when you opened the door of that refrigerator, all you could see were pomegranates.

  I lost fifteen pounds that month. Jim, who had nothing to lose, lost twenty.

  As for the rest: Jim’s tumor markers did go down a little on the Ron Weiss diet, though not as dramatically as we’d hoped. It is definitely true that we both felt surprisingly good after a month of eating this way, though we also missed the pleasure of food as something more than pure sustenance.

  But at the end of six weeks of living on the diet, Jim threw in the towel. “If I keep living on these salads I’ll fade away,” he said. His weight was down to 108.

  That night we grilled him a steak and made a Caesar salad with Parmesan cheese, egg yolks, anchovies. I shared in the meal, along with a bottle of cabernet, and after, we ate pie.

  We still tried to keep up with the pomegranates. But we couldn’t get through them fast enough. We’d open one up, and instead of beautiful little red jewel seeds, we’d find the fruit rotten.

  So one night we carried what was left of the pomegranates outside into the same field behind our house where I had thrown away the seafood I’d bought for the paella party that never happened. One by one, whooping and laughing, Jim and I flung what was left of our pomegranate stores into the woods.